19 October 2010

GruntDoc posted about the classic ER doctor's nightmare: “You know that patient you saw yesterday?” was how the conversation started.

I've been there. I know the bolt of adrenaline, the cautious, "Yeah, why do you ask?" that you always respond with. But one thing that our Brave New Technological World has brought to us is this: the email of doom.

Your institution may vary, but for us, the adrenaline-producing email comes with the subject line of "SECURE Email for Dr. Shadowfax" and it links to the hospital's (damned) HIPAA compliant encrypted webmail interface. Nobody ever uses it because it's a hideous pain in the ass, except the official hospital quality officer who is responsible for reviewing all "Unusual Occurrences," which is the euphemism for unexpected deaths, bad outcomes, 24 hour returns, patient complaints, nursing complaints, etc. Nothing good. So when you see the awful subject line, you just know that whatever is waiting in there for you is an unpleasant little Christmas present, the sort you don't really want to unwrap but you have to. Just as an extra bit of pain they make sure the login process is as slow and cumbersome as possible. Two entries of your password (which has to be changed every ninety days, natch, and you can't re-use passwords).

The awful, truly awful thing about these emails is that they are only generated by BAD things. There's no possibility that this will be a patient compliment, or a "well done." So as soon as you see the header you are bracing yourself for whatever bit of awfulness lies within. It's not necessarily anything your fault. People get worse. Subtle presentations become more clear over time. Nurses mess things up and patients complain about the dirty guy in the waiting room (these also go to the secure email, for your comment). But as soon as you see the "SECURE Email" header, you are sure that it was that dizzy guy from yesterday, and you're cursing yourself for sending him home until you finish the login process and find out that it was really some dude unhappy that you only gave him ten vicodin.

I think that sometimes our medical director sends out trivial emails on the secure email system just to screw with our heads.

Of course it goes both ways. As the "boss" for our group I have found that people dread seeing my name on the caller ID, and the meanest thing I can do is leave someone a voice mail saying that I need to meet with them. It's like when you were a kid and you got called to the principal's office, that sense of "What did I do?" (or in my case, "What did I do that you found out about and can you pin it on me?"). So I try to be really clear when I'm calling about a minor thing so people don't freak out, but the power of intimidation is amazing, even when I don't want to be intimidating, which is pretty much all of the time. Worse, sometimes I do have to call someone in for a "real meeting," and that's just hateful all around.

I also remember the old medical director, a close friend, used to call from the office just to chat, and when I saw the caller ID I also had the panicked sense of "Crap, what did I do?" until I answered and found out he just wanted to talk about the Chicago Bears.

Which in my mind ranks right up there with sending out trivial emails on the SECURE system as the hallmark of an absolute bastard.

" Just as an extra bit of pain they make sure the login process is as slow and cumbersome as possible. Two entries of your password (which has to be changed every ninety days, natch, and you can't re-use passwords)."

That's an easy one. Pick a password you like, and stick a number on the end of it. Or the front, dosen't really matter. Then, when it's time to change your password,increment the number by one.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

Disclaimer

This blog is for general discussion, education, entertainment and amusement. Nothing written here constitutes medical advice nor are any hypothetical cases discussed intended to be construed as medical advice. Please do not contact me with specific medical questions or concerns. All clinical cases on this blog are presented for educational or general interest purposes and every attempt has been made to ensure that patient confidentiality and HIPAA are respected. All cases are fictionalized, either in part or in whole, depending on how much I needed to embellish to make it a good story to protect patient privacy.

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